Academic Commons Search Resultshttp://academiccommons.columbia.edu/catalog.rss?f%5Bdepartment_facet%5D%5B%5D=Economics&f%5Bsubject_facet%5D%5B%5D=Public+health&q=&rows=500&sort=record_creation_date+desc
Academic Commons Search Resultsen-usMines: The Local Welfare Effects of Mineral Mining in Developing Countrieshttp://academiccommons.columbia.edu/catalog/ac:171770
von der Goltz, Jan; Barnwal, Prabhathttp://dx.doi.org/10.7916/D8348HFDThu, 13 Mar 2014 00:00:00 +0000Do residents of mining communities face health-wealth trade-offs? We conduct the first extensive investigation assessing this question using micro-data from communities near about 800 mineral mines in 44 developing countries. Mining communities enjoy a substantial medium term rise in asset wealth (0.3σ), but experience a nine percentage point increase in anemia among adult women, and a five percentage point increase in the prevalence of stunting in young children. Both of these health impacts have previously been linked to metal toxicity - and in particular, exposure to high levels of environmental lead. Benefits and costs are strongly concentrated in the immediate vicinity (5km) of the nearest mine. We find no systematic evidence of general ill health, and we observe health impacts only near mines of a type where lead pollution is to be expected. Identification is based on a mine-level and mother-level panel, and in the cross-section, on group effects. A novel instrumental variable serves as a cross-sectional robustness check. To make plausible that the observed health impacts are due to pollution, we develop difference-in-difference tests based on the known association of certain mine types with lead pollution, and based on the pathophysiology of lead toxicity. Our results represent the first comprehensive assessment of the local welfare impacts of mining in developing countries, and add to the evidence suggesting that communities near industrial centers in developing countries face information or cost constraints that limit their choice sets.Economics, Public healthpb2442Economics, International and Public AffairsWorking papersDiagnosis and Unnecessary Procedure Use: Evidence from C-Sectionhttp://academiccommons.columbia.edu/catalog/ac:167846
Currie, Janet; MacLeod, W. Bentleyhttp://dx.doi.org/10.7916/D87M05W4Tue, 26 Nov 2013 00:00:00 +0000This paper develops and applies a model in which doctors have two dimensions of skill: diagnostic skill and skill performing procedures. Higher procedural skill increases the use of intensive procedures across the board, while better diagnostic skill results in fewer intensive procedures for the low risk, but more for the high risk. Deriving empirical analogues to our theoretical measures for the case of C- section, we show that improving diagnostic skill would reduce C-section rates by 15.8% among the lowest risk, and increase them by 4.7% among the high risk while improving outcomes among all women.Economics, Public health, Medicinewbm2103Economics, International and Public AffairsWorking papersThe Myth of Child Malnutrition in Indiahttp://academiccommons.columbia.edu/catalog/ac:156283
Panagariya, Arvindhttp://hdl.handle.net/10022/AC:P:18937Wed, 06 Feb 2013 00:00:00 +0000A common continuing criticism of the economic reforms in India has been that despite accelerated growth and all-around poverty reduction, the country continues to suffer from child malnutrition that is worse than nearly all of the Sub Saharan African countries with lower per-capita incomes. Nearly half of India’s under-five children are said to be underweight and stunted. Prime Minister Manmohan Singh recently described the problem as ‘a matter of national shame.’ I argue in this paper that this narrative, nearly universally accepted around the world, is both false and counter-productive from the viewpoint of policy formulation. It is purely an artifact of a faulty methodology that the World Health Organization has pushed and the United Nations has supported. If the numbers are correctly done, in all likelihood, India will have no more to be ashamed of its achievements in child nutrition than vital statistics such as life expectancy, infant mortality and maternal mortality.Public health, Economicsap2231Economics, International and Public AffairsReportsPreconception Health and Health Care and Early Childhood Comprehensive Systems: Opportunities for Collaborationhttp://academiccommons.columbia.edu/catalog/ac:146803
Rossin-Slater, Maya; Brellochs, Christelhttp://hdl.handle.net/10022/AC:P:13189Tue, 08 May 2012 00:00:00 +0000In recent years, the importance of women's preconception health and health care (PCHHC) for improving birth outcomes, especially among high-risk populations, has been highlighted by numerous researchers, advocates, and policymakers. In 2006, the Centers for Disease Control and Prevention (CDC) Select Panel on Preconception Care issued recommendations for improving preconception health and health care. Throughout this report, we refer to preconception health and health care as efforts to promote women's wellbeing and health before, during, and between pregnancies and throughout their childbearing years. A growing body of evidence points to the importance of a woman's physical, mental, environmental, and behavioral health over her life course for her children's birth outcomes, and consequent child development and later life wellbeing. The Early Childhood Comprehensive Systems (ECCS) initiative can play an important role in advancing PCHHC, benefiting women, young children, and families in their communities.Public health, Women's studiesmr2856National Center for Children in Poverty, EconomicsReportsEssays on Malaria, Environment and Societyhttp://academiccommons.columbia.edu/catalog/ac:141904
McCord, Gordon C.http://hdl.handle.net/10022/AC:P:11814Fri, 18 Nov 2011 00:00:00 +0000The body of work presented here seeks to illuminate the complex relationship between human society, development, and environment for the case of malaria. While malaria profoundly affects human society and prospects for prosperity, public health measures and anthropogenic environmental change alter the intensity of transmission differentially around the globe. Using global maps of malaria risk, the first chapter finds that the elimination of the disease during the course of the 20th century occurred in places where the strength of transmission was weaker due to suboptimal ecology, and that this result holds even after controlling for income levels. The next chapter employs GIS datasets on population, urbanization, malaria risk, and malaria endemicity to spatially estimate the cost of fully deploying ecology-appropriate anti-malaria interventions in Africa; the cost of curbing malaria is found to be small (around $4 per person at risk per year), especially given its high disease burden and subsequent social and economic costs. I next construct a spatial month-to-month ecological index of malaria transmission strength, and use a climate change model to predict changes in ecological transmission strength of malaria and estimate the implied changes in incidence and mortality given current technology and public health efforts. The final chapter uses the malaria ecology index as an instrumental variable to estimate the effect of child mortality on fertility behavior. The large effect of child mortality indicates that malaria has an indirect effect on society beyond morbidity and mortality: high malaria burdens increase fertility rates, thus slowing the demographic transition. These chapters span the fields of epidemiology, public health systems, climate science, economics and demography in order to holistically model the relationship between malaria and human systems; such understanding of coupled human-natural systems will be vital to policy making for sustainable development.Economics, Public health, Public policygm2101Sustainable Development, Economics, Health Policy and Management, Earth Institute, International and Public AffairsDissertationsEducation's Role in Explaining Diabetic Health Investment Differentialshttp://academiccommons.columbia.edu/catalog/ac:100302
Kahn, Matthew E.http://hdl.handle.net/10022/AC:P:15674Mon, 22 Aug 2011 00:00:00 +0000Diabetic tight blood sugar control minimizes the likelihood of complications. This study focuses on quantifying education's role in explaining diabetic investment in health capital. Ability and information proxies are used to test whether education's positive effect on diabetic compliance is causal. The paper's key finding is that education continues to have a positive impact on diabetic health investment even after controlling for IQ and available information.Education, Public healthmk214EconomicsWorking papersThe AIDS Epidemic and Economic Policy Analysishttp://academiccommons.columbia.edu/catalog/ac:100133
Bloom, David E.; Mahal, Ajay S.http://hdl.handle.net/10022/AC:P:15621Fri, 12 Aug 2011 00:00:00 +0000Economists have a vital role to play in helping public health officials and policymakers understand the AIDS epidemic and design efficient policies to limit its impact. AIDS is first and foremost a public health problem, but it is a problem with deep economic roots and potentially devastating economic consequences. The main purpose of this article is to document this assertion.Economics, Public healthEconomics, Economics (Barnard College)Working papersProjecting the Number of New AIDS Cases in the U.S.http://academiccommons.columbia.edu/catalog/ac:99761
Bloom, David E.; Glied, Sherry A. M.http://hdl.handle.net/10022/AC:P:15506Fri, 12 Aug 2011 00:00:00 +0000This paper reviews the two leading methods used to project the number of AIDS cases: back calculation and extrapolation. These methods are assessed in light of key features of the HIV/AIDS epidemic and of data on the epidemic; they are also assessed in terms of the quality of the projections they yield. Our analysis shows that both methods have tended to overproject, often by sizable amounts, the number of AIDS cases in the U.S., especially among homosexual/bisexual males and users of blood and blood products. Our results provide no evidence that the use of AZT and other prophylaxis accounts for these projection errors. Rather, the overprojections appear to be mainly the result of a considerable reduction in the rate of new HIV infection among the gay community starting in 1983-85. A new method for projecting AIDS cases is proposed that exploits knowledge about the process generating AIDS cases and that incorporates readily available information about rates of new HIV infection. This method is far less sensitive to estimates of the incubation distribution than the method of back calculation and is shown, for the two transmission categories studied, to generate far more accurate AIDS case projections through 1990 than those based on the method of extrapolation. Relative to the method of extrapolation, this method projects 22,000 fewer new AIDS cases for 1995 (a 36 percent difference). This method also projects that intravenous drug users will replace homosexual/bisexual men as the dominant transmission category for AIDS.Economics, Public healthsag1Economics, Health Policy and ManagementWorking papersA new global effort to control malariahttp://academiccommons.columbia.edu/catalog/ac:116520
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:517Thu, 24 Mar 2011 00:00:00 +0000The global campaign to eradicate malaria, launched in 1955 and phased out by the end of the 1960s, has been dubbed a misguided failure. Although the campaign did not come close to achieving its headline objective of eradicating malaria, it did lead to enormous and sustained reductions in the burden of malaria in dozens of countries around the world. Unfortunately, the world failed to heed the right lesson: global eradication is not feasible, but sustained malaria control restricting transmission to low levels is. The time has come to resurrect a worldwide effort to control malaria, albeit one not predicated on complete eradication of the disease.Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsWorking papersBypassing health centers in Tanzania: Revealed preferences for observable and unobservable qualityhttp://academiccommons.columbia.edu/catalog/ac:113198
Leonard, Kenneth L.; Mliga, Gilbert R.; Mariam, Damien H.http://hdl.handle.net/10022/AC:P:376Tue, 22 Mar 2011 00:00:00 +0000When patients bypass one health facility to seek health care at another, strong preferences are revealed. This paper advances the view that the patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients' understanding of various measures of quality at the facilities that they visit and bypass. Importantly some of these measures are 'unobservable,' meaning that we do not expect patients to be able to evaluate whether or not these types of quality are present just from visiting a center. We use two data sets on various features of health facilities including consultation quality and prescription quality as evaluated by a team of clinicians. This is matched with data collected from health center registers that included the symptoms of patients and the village they traveled from. The register data is transformed into a patient-based sample and we use a multinomial/conditional logit regression on patient choice of provider to show the relationship between patient behavior and objective measure of technical quality in the health facilities. Patients seek facilities that provide high quality consultations, are staffed by more knowledgeable physicians, observe prescription practices, and are polite. They avoid facilities that use injections too liberally or over-prescribe medication.Economics, Public healthkl206EconomicsWorking papersMeasuring the relative performance of providers of a health servicehttp://academiccommons.columbia.edu/catalog/ac:114049
Machado, Matilde P.; Riordan, Michael H.; Ackerberg, Daniel A.http://hdl.handle.net/10022/AC:P:412Tue, 22 Mar 2011 00:00:00 +0000A methodology is developed and applied to compare the performance of publicly funded agencies providing treatment for alcohol abuse in Maine. The methodology estimates a Wiener process that determines the duration of completed treatments, while allowing for agency differences in the effectiveness of treatment, standards for completion of treatment, patient attrition, and the characteristics of patient populations. Notably, the Wiener process model separately identifies agency fixed effects that describe differences in the effectiveness of treatment ('treatment effects'), and effects that describe differences in the unobservable characteristics of patients ('population effects'). The estimated model enables hypothetical comparisons of how different agencies would treat the same populations. The policy experiment of transferring the treatment practices of more cost effective agencies suggests that Maine could have significantly reduced treatment costs without compromising health outcomes by identifying and transferring best practices.Economic theory, Public healthmhr21EconomicsWorking papersInstitutional Structure of Health Care in Rural Cameroun: Structural Estimation of Production in Teams with Unobservable Efforthttp://academiccommons.columbia.edu/catalog/ac:100491
Leonard, Kenneth L.http://hdl.handle.net/10022/AC:P:15732Mon, 07 Mar 2011 00:00:00 +0000Traditional healers in Cameroun are paid on an outcome-contingent basis, where payments are linked to the recovery of the patient. On the other hand, organizational providers (government clinics and hospitals and church-based clinics and hospitals) are paid a fixed fee at the time of consultation. Is this "custom" of payment method at the traditional healer a response to a problem of imperfect information in the supply of medical care? Eswaran and Kotwal (1985) suggest that share-cropping is a response to imperfect information in the supply of factor inputs owned by land-lords and tenants. Because different crops require different levels of inputs, one form of contract might be particularly appropriate for some crops but not others. We suggest that contingent-payment contracts are appropriate for some health production technologies and that fixed fee contracts are appropriate for other technologies, where a technology in health care is the medical response indicated be a set of presenting conditions. We fit a contractual model of health care demand to date on observed patterns of provider and contract choice using a Conditional Logit. Effort exerted on behalf of the patient's health is unobservable and is therefore only delivered according to the incentives that exist within the implicit contract between patient and provider. Patients create an approximate market for medical effort by choosing between discreet contract types. Institutions and organizations play an essential role in the creation of credible quality. With simulation we show that the government can greatly reduce transaction costs (and increase net utility) by specifically recognizing its role as an organization within the context of the institution of modern health care.Economics, Public healthkl206EconomicsWorking papersAsymmetric Information and the Role of NGOs in African Health Carehttp://academiccommons.columbia.edu/catalog/ac:100520
Leonard, Kenneth L.; Leonard, David K.http://hdl.handle.net/10022/AC:P:15741Mon, 07 Mar 2011 00:00:00 +0000In African health care the "miracle of the market "has not occurred. Patients exhibit willingness to pay for health care and yet practitioners are unable to sell their services. Simultaneously non-governmental organizations (NGOs) are running successful health facilities for which patients are willing to pay. We develop a model of the demand for health care in the presence of asymmetric information that allows us to view African health care in the framework of the New Institutional Economics literature. We use previously published empirical results to support the validity of this view and show that NGOs have the institutional capacity to deliver high quality health care, whereas private practitioners, even with good intentions, will not easily succeed. Having arrived at the well documented conclusion that NGOs provide high quality services through theory allows us to draw policy conclusions on ways to extend the provision of health services.Economics, Public healthkl206EconomicsWorking papersInstitutional Solutions to the Principal-Agent Problem in African Health Carehttp://academiccommons.columbia.edu/catalog/ac:100497
Leonard, Kenneth L.; Leonard, David K.http://hdl.handle.net/10022/AC:P:15734Mon, 07 Mar 2011 00:00:00 +0000Free markets for health care in Africa do not function properly, in that patients exhibit willingness to pay for health care and yet practitioners are unable to sell their services. It is widely acknowledged that health markets everywhere are troubled with imperfect information. Therefore it is no surprise that free markets and spot contracts do not lead to an efficiently functioning market for health care. When issues of agency are not resolved we find practitioners specializing in the sale of pharmaceuticals but not using their skills as diagnosticians. Mechanisms that can reduce agency cost are beneficial to both patients and practitioners. This paper draws on theory and empirical evidence to examine what institutions are necessary to solve the problems of imperfect information in this context. We dismiss government regulation because the regulatory capacity does not exist in most African countries. Theory suggests that self-regulation by professional bodies should arise as privatization continues. Empirical evidence, however, suggests that this conclusion is overly-optimistic. On the other hand, referral networks perform much the same function but do not require centralized control. The most successful institution for the delivery of quality medical care in Africa is that of independent, pre-existing value-based organizations (missions) and we suggest their choice of institutional form has contributed to their success.Economics, Public healthkl206EconomicsWorking papersBypassing Health Centers in Tanzania: Revealed Preferences for Observable and Unobservablehttp://academiccommons.columbia.edu/catalog/ac:99749
Leonard, Kenneth L.; Mliga, Gilbert R.; Mariam, Damen H.http://hdl.handle.net/10022/AC:P:15502Mon, 07 Mar 2011 00:00:00 +0000When patients bypass on one health facility to seek health care at another, strong preference are revealed. This paper advances the view that the patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients understanding of various measures of quality at the facilities that they visit and bypass. Importantly some of these measures are "unobservable", meaning that we do not expect patients to be able to evaluate whether or not these types of quality are present just from visiting a center. We use two data sets on various features of health facilities including consultation quality and prescription quality as evaluated by a team of clinicians. This is matched with data collected from health center registers that included the symptoms of patients and the village they traveled from. The register data is transformed into a patient-based sample and we use a multinomial/conditional logit regression on patient choice of provider to show the relationship between patient behavior and objective measure of technical quality in the health facilities. Patients seek facilities that provide high quality consultations, are staffed by more knowledgeable physicians, observe prescription practices and are polite. They avoid facilities that use injections too liberally or over-prescribe medicationEconomics, Public healthkl206EconomicsWorking papersAfrican Traditional Healers: Incentives and Skill in Health Care Deliveryhttp://academiccommons.columbia.edu/catalog/ac:100480
Leonard, Kenneth L.http://hdl.handle.net/10022/AC:P:15729Thu, 03 Mar 2011 00:00:00 +0000The benefit of health care comes not just from the ability of health care providers to produce health but from their motivation to do so as well. The fact that traditional healers in Africa are paid on the basis of health outcomes not services provided changes the incentives they face compared to those of modern health care providers. This paper documents these payment methods in Cameroun and explores the different incentives faced by practitioners in government and church-based facilities as well as traditional healers. To test whether such incentives make a difference in the provision of health care I use a multinomial logit analysis of an original data set from Cameroun on patients' choice of provider and show that patients choose practitioners as if they were aware of the difference in incentives. Thus, though patients cannot perfectly evaluate the quality of health they receive or would have received, they can evaluate expected quality by examining incentives.Economics, Public healthkl206EconomicsWorking papersDoes the AIDS Epidemic Really Threaten Economic Growth?http://academiccommons.columbia.edu/catalog/ac:100139
Bloom, David E.; Mahal, Ajay S.http://hdl.handle.net/10022/AC:P:15623Wed, 02 Mar 2011 00:00:00 +0000This study examines the claim that the AIDS epidemic will slow the pace of economic growth. We do this by examining the association, across fifty-one developing and industrial countries for which we were able to assemble data, between changes in the prevalence of AIDS and the rate of growth of GDP per capita. Our analysis uses well-established empirical growth models to control for a variety of factors possibly correlated with AIDS prevalence that migt also influence growth. We also account for possible simultaneity in the relationship between AIDS and economic growth. Our main finding is that the AIDS epidemic has had an insignificant effect on the growth rate of per capita income, with no evidence of reverse causality. We also find evidence that the insignificant effect of AIDS on income per capita is qualitatively similar to an insignificantly effect on wages of the Black Death in England and France during the Middle Ages and an insignificant effect on output per capita of influenza in India during 1918-19.Economics, Public healthEconomics, Economics (Barnard College)Working papersThe Cost Of Diabeteshttp://academiccommons.columbia.edu/catalog/ac:100075
Kahn, Matthew E.http://hdl.handle.net/10022/AC:P:15603Mon, 28 Feb 2011 00:00:00 +0000Diabetics must choose how much effort to devote to health care. Technological innovation and product differentiation have lowered the price of diabetic compliance. It is now easier to frequently test blood and to adjust insulin levels. The quality of sugar free food substitutes have greatly improved. New diabetic cohorts should be healthier than previous cohorts. This paper uses the 1976 and 1989 cross sections of the National Health Interview Surveys to study output indicators, such as income and labor force participation, and input indicators, such as diet and weight, of diabetics and non diabetics to evaluate this "convergence" hypothesis.Economics, Public healthmk214EconomicsWorking papersWho is Bearing the Cost of the AIDS Epidemic in Asia?http://academiccommons.columbia.edu/catalog/ac:99810
Glied, Sherry A. M.; Bloom, David E.http://hdl.handle.net/10022/AC:P:15521Thu, 17 Feb 2011 00:00:00 +0000This chapter infers the distribution of AIDS costs in India, Indonesia, and Thailand from data on the costs of detecting and treating AIDS and from information on the nature of different countries health care finance systems and related institutions. The main finding is that the AIDS epidemic will contribute to increased economic inequality in these countries because (a) it is disproportionately affecting low-income groups and (b) public and private institutions that could spread the costs of the epidemic (for example, health, life, disability, and social welfare insurance) are relatively limited and do not reach the majority of the populations. The chapter also develops a new approach to measuring AIDS medical care costs that yields estimates of US $738 per case in India and US $1490 per case in Indonesia. Finally, the chapter discusses the political economy of HIV prevention and speculates that more effective control of the epidemic may result from a system in which the government pays for the medical care costs of AIDS than one in which individuals with AIDS and their families bear most of the costs.Economics, Public healthsag1Economics, Health Policy and ManagementWorking papersAir pollution and infant health: lessons from New Jerseyhttp://academiccommons.columbia.edu/catalog/ac:129470
Currie, Janet M.; Neidell, Matthew J.; Schmieder, Johannes F.http://hdl.handle.net/10022/AC:P:9785Wed, 12 Jan 2011 00:00:00 +0000We examine the impact of three "criteria" air pollutants on infant health in New Jersey in the 1990s by combining information about mother's residential location from birth certificates with information from air quality monitors. Our work offers three important innovations: First, we use the exact addresses of mothers to select those closest to air monitors to improve the accuracy of air quality exposure. Second, we include maternal fixed effects to control for unobserved characteristics of mothers. Third, we examine interactions of air pollution with smoking and other risk factors for poor infant health outcomes. We find consistently negative effects of exposure to carbon monoxide, both during and after birth, with effects considerably larger for smokers and older mothers. Since automobiles are the main source of carbon monoxide emissions, our results have important implications for regulation of automobile emissions.Environmental studies, Public healthjc2663, mn2191, jfs2106Economics, Columbia Population Research Center, Health Policy and ManagementWorking papersFetal exposures to toxic releases and infant healthhttp://academiccommons.columbia.edu/catalog/ac:129473
Currie, Janet M.; Schmieder, Johannes F.http://hdl.handle.net/10022/AC:P:9786Wed, 12 Jan 2011 00:00:00 +0000Every year, millions of pounds of toxic chemicals thought to be linked to developmental problems in fetuses and young children are released into the air. In this paper we estimate the effect of these releases on the health of newborns. Using data from the Toxic Release Inventory Program and Vital Statistics Natality and Mortality files, we find significant negative effects of prenatal exposure to toxicants on gestation and birth weight. We also find that several developmental chemicals increase the probability of infant death. The effect is quite sizeable: the reported reductions in cadmium, toluene, and epichlorohydrin releases during the 90s could account for about 3.9 percent of the overall decrease in infant mortality. Our results are robust to several specification checks, such as comparing developmental to non-developmental chemicals, and fugitive air releases to stack air releases.Environmental studies, Public healthjc2663, jfs2106Economics, Columbia Population Research CenterWorking papersHealth in the developing world: achieving the Millennium Development Goalshttp://academiccommons.columbia.edu/catalog/ac:124465
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8373Tue, 26 Jan 2010 00:00:00 +0000The Millennium Development Goals depend critically on scaling up public health investments in developing countries. As a matter of urgency, developing-country governments must present detailed investment plans that are sufficiently ambitious to meet the goals, and the plans must be inserted into existing donor processes. Donor countries must keep the promises they have often reiterated of increased assistance, which they can easily afford, to help improve health in the developing countries and ensure stability for the whole world.Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsArticlesDoctors, Patients, and the Racial Mortality Gap: What Are the Causes?http://academiccommons.columbia.edu/catalog/ac:124267
Simeonova, Emiliahttp://hdl.handle.net/10022/AC:P:8327Tue, 19 Jan 2010 00:00:00 +0000Disparities in health outcomes between white and minority Americans are a significant and well documented challenge in improving equity in healthcare. Two frequently cited explanations are discrimination in treatment - doctors treating minority patients differently, and unequal access to care - patients being trapped in facilities of inferior quality. I use a new dataset from the Department of Veterans Affairs and employ a novel estimation strategy to investigate the sources of the racial gap in mortality for chronic heart disease, the most expensive chronic condition in the elderly. I find that racial differences in mortality persist even when the quality of clinics and doctors is controlled for. Investigating the doctor-patient interaction, I show that doctor quality significantly influences patient outcomes. While minority patients visit slightly less competent doctors, this does not explain the large gap in survival. Individual doctors are found to treat their patients similarly regardless of race. On the patient side, I demonstrate that variation in compliance triggers a racial mortality gap. Differences in patient response to treatment significantly alter survival probabilities. Considerable reductions in medical costs could be achieved by convincing patients of the importance of strictly following the therapy regimen. I estimate that targeting compliance patterns could reduce the black-white mortality gap by at least two-thirds.Economics, Public healthEconomicsWorking papersAchieving the Millennium Development Goals: The Case of Malariahttp://academiccommons.columbia.edu/catalog/ac:124453
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8369Mon, 12 Oct 2009 00:00:00 +0000Malaria currently kills up to 3 million people per year worldwide, most of them children in sub-Saharan Africa. Yet the disease is utterly treatable and highly preventable. Now, the international community has vowed as part of its Millennium Development Goals to make appropriate investments and interventions to bring this scourge under control. These goals, adopted by world leaders at the United Nations Millennium Assembly in September 2000, represent a commitment to reducing extreme poverty and diseases such as malaria sharply by 2015. Among other objectives, the eight development goals call for reducing by half the rates of extreme poverty and hunger by 2015 and reducing childhood mortality by two thirds and maternal mortality by three fourths relative to their 1990 levels. The goals also target the control of the great pandemic diseases — human immunodeficiency virus (HIV) and AIDS, tuberculosis, and malaria. In 2002, the high-income countries, including the United States, made a commitment to substantially increasing their aid to poor countries in order to meet these ambitious but achievable targets, though the actual flow of aid has not yet increased markedly.Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsArticlesSBRI Presentationhttp://academiccommons.columbia.edu/catalog/ac:124164
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8300Fri, 02 Oct 2009 00:00:00 +0000Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsPresentationsAfrican HIV/AIDS Crisis: Pursuing Both Treatment and Preventionhttp://academiccommons.columbia.edu/catalog/ac:124185
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8306Fri, 02 Oct 2009 00:00:00 +0000Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsPresentationsAchieving the Millennium Development Goals: Health in the Developing Worldhttp://academiccommons.columbia.edu/catalog/ac:123984
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8262Thu, 01 Oct 2009 00:00:00 +0000Public health, Area planning and developmentjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsPresentationsWinning the Fight Against Disease: A New Global Strategyhttp://academiccommons.columbia.edu/catalog/ac:124029
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8275Thu, 01 Oct 2009 00:00:00 +0000Public health, Area planning and developmentjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsArticlesA Miserly Response to a Global Emergencyhttp://academiccommons.columbia.edu/catalog/ac:124023
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8273Thu, 01 Oct 2009 00:00:00 +0000Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsArticlesAmerica should not fight AIDS on its ownhttp://academiccommons.columbia.edu/catalog/ac:124014
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8270Thu, 01 Oct 2009 00:00:00 +0000Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsArticlesThe Economic Burden of Malariahttp://academiccommons.columbia.edu/catalog/ac:124098
Gallup, John Luke; Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8064Thu, 01 Oct 2009 00:00:00 +0000Malaria and poverty are intimately connected. Controlling for factors such as tropical location, colonial history, and geographical isolation, countries with severe malaria had income levels in 1995 only 33% of countries without malaria, whether or not the countries were in Africa. The high levels of malaria in poor countries are not mainly a consequence of poverty. Malaria is very geographically specific. The ecological conditions that support the more efficient malaria mosquito vectors primarily determine the distribution and intensity of the disease. Intensive eradication efforts in the most severely affected countries have been largely ineffective. Countries that have eradicated malaria in the past half century have all been subtropical or islands. These countries' economic growth in the five years following eradication has almost always been substantially higher than growth in their region. Cross-country regressions for the 1965-90 period confirm the relationship between malaria and economic growth. Taking into account initial poverty, economic policy, tropical location, and life expectancy among other factors, countries with severe malaria grew 1.3% lower per year, and a 10% reduction in malaria was associated with 0.3% higher growth per year. The paper concludes with speculation about the mechanisms that could cause malaria to have such a large impact on the economy, including the possibility that the effects attributed to malaria are really the result other unmeasured tropical diseases.Economics, Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsArticlesImproving Global Health in the Developing Worldhttp://academiccommons.columbia.edu/catalog/ac:123957
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8253Wed, 30 Sep 2009 00:00:00 +0000Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsArticlesHIV Non-Intervention: A Costly Option: A New Framework for Globalizationhttp://academiccommons.columbia.edu/catalog/ac:124089
Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8060Wed, 30 Sep 2009 00:00:00 +0000Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsPresentationsAfrica's Lagging Demographic Transition: Evidence from Exogenous Impacts of Malaria Ecology and Agricultural Technologyhttp://academiccommons.columbia.edu/catalog/ac:124071
Conley, Dalton; McCord, Gordon C.; Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8055Tue, 29 Sep 2009 00:00:00 +0000Much of Africa has not yet gone through a "demographic transition" to reduced mortality and fertility rates. The fact that the continent's countries remain mired in a Malthusian crisis of high mortality, high fertility, and rapid population growth (with an accompanying state of chronic extreme poverty) has been attributed to many factors ranging from the status of women, pro-natalist policies, poverty itself, and social institutions. There remains, however, a large degree of uncertainty among demographers as to the relative importance of these factors on a comparative or historical basis. Moreover, econometric estimation is complicated by endogeneity among fertility and other variables of interest. We attempt to improve estimation (particularly of the effect of the child mortality variable) by deploying exogenous variation in the ecology of malaria transmission and in agricultural productivity through the staggered introduction of Green Revolution, high-yield seed varieties. Results show that child mortality (proxied by infant mortality) is by far the most important factor among those explaining aggregate total fertility rates, followed by farm productivity. Female literacy (or schooling) and aggregate income do not seem to matter as much, comparatively.Demography, Public health, Economics, Asian studiesgm2101, js2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsWorking papersScaling Up Primary Health Services in Rural India: Public Investment Requirements and Health Sector Reform: Case Studies of Uttar Pradesh and Madhya Pradeshhttp://academiccommons.columbia.edu/catalog/ac:123815
Bajpai, Nirupam; Dholakia, Ravindra H.; Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8211Mon, 28 Sep 2009 00:00:00 +0000We attempt to address two key questions in this paper: 1) In terms of state-wide scaling up of rural services (in Uttar Pradesh, and Madhya Pradesh) in the area of primary health, what will it cost financially and in terms of human resources to scale-up these services in all the rural areas of these two states? And 2) What policy, institutional and governance reforms may be necessary so as to ensure proper service delivery? As is well known, merely setting up more health clinics, for instance, is not going to be enough; higher public investments in these areas needs to be accompanied by systemic reforms that will help overhaul the present service delivery system, including issues of control and oversight, for example.Public health, Area planning and development, South Asian studiesnb2046, js2201Center on Globalization and Sustainable Development, Economics, Health Policy and Management, Earth Institute, International and Public AffairsWorking papersScaling Up Primary Health Services in Rural Tamil Nadu: Public Investment Requirements and Health Sector Reformhttp://academiccommons.columbia.edu/catalog/ac:123824
Bajpai, Nirupam; Dholakia, Ravindra H.; Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8213Mon, 28 Sep 2009 00:00:00 +0000We attempt to address two key questions in this paper: 1) In terms of state-wide scaling up of rural services in the area of primary health, what will it cost financially and in terms of human resources to scale-up these services in all the rural areas of the state? And 2) what policy, institutional and governance reforms may be necessary so as to ensure proper service delivery? As is well known, merely setting up more health clinics, for instance, is not going to be enough; higher public investments in these areas needs to be accompanied by systemic reforms that will help overhaul the present service delivery system, including issues of control and oversight, for example.Public health, Area planning and development, South Asian studiesnb2046, js2201Center on Globalization and Sustainable Development, Economics, Health Policy and Management, Earth Institute, International and Public AffairsWorking papersThe Effect of the AIDS Epidemic on Economic Welfare in Sub-Saharan Africahttp://academiccommons.columbia.edu/catalog/ac:123830
Jamison, Dean T.; Sachs, Jeffrey D.; Wang, Jiahttp://hdl.handle.net/10022/AC:P:8214Mon, 28 Sep 2009 00:00:00 +0000The existing literature on health and development contains increasing numbers of assessments of relations between health conditions of countries and their per capita GDP, but it has not assessed health as an aspect of economic welfare. Early work of Usher and more recent work of Nordhaus and others has, however, begun to use empirical assessments of what societies appear willing to pay to reduce death rates (e.g. through costly environmental or safety regulations) to allow incorporation of mortality change into measures of changes in economic welfare that are more comprehensive than the rate of change in per capita GDP. This paper applies the method utilized by Nordhaus to assess the contribution of mortality changes in Sub-Saharan Africa to rates of change in economic welfare. Between 1960 and 1990 life expectancy in Africa increased by a very substantial 9 years. The impact was to add between 1.7% and 2.7% per annum to the growth rate of per capita GDP in generating a more inclusive measure of change in economic welfare. The AIDS epidemic, however, is more than reversing these gains: for Africa as a whole the AIDS induced decline in economic welfare was about 1.7% per annum, leading to an overall growth rate of welfare of –2.6% . In countries heavily impacted by AIDS, Bostwana for example, the effect has been to decrease economic welfare by over 8% per year for the past decade.Public health, Sub-Saharan Africa studiesjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsWorking papersEconomic Consequences of Health Status: A Review of the Evidencehttp://academiccommons.columbia.edu/catalog/ac:123665
Hamoudi, Amar A.; Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8171Fri, 25 Sep 2009 00:00:00 +0000The correlation between health and economic performance is extremely robust across communities and over time. Many factors exogenous to income play an important role in determining health status, including a number of geographical, environmental, and evolutionary factors. This suggests the existence of simultaneous impacts of health on wealth and wealth on health. Potential health impacts on national economic performance are explored, and some important unanswered questions are identified.Economics, Public healthjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsWorking papersThe Economic Burden of Malariahttp://academiccommons.columbia.edu/catalog/ac:124074
Gallup, John Luke; Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8427Fri, 25 Sep 2009 00:00:00 +0000Malaria and poverty are intimately connected. Controlling for factors such as tropical location, colonial history, and geographical isolation, countries with intensive malaria had income levels in 1995 only 33% of countries without malaria, whether or not the countries were in Africa. The high levels of malaria in poor countries are not mainly a consequence of poverty. Malaria is very geographically specific. The ecological conditions that support the more efficient malaria mosquito vectors primarily determine the distribution and intensity of the disease. Intensive efforts to eliminate malaria in the most severely affected countries in the tropics have been largely ineffective. Countries that have eliminated malaria in the past half century have all been either subtropical or islands. These countries’ economic growth in the five years after eliminating malaria has usually been substantially higher than growth in the neighboring countries. Regressions using cross-country data for the 1965-90 period confirm the relationship between malaria and economic growth. Taking into account initial poverty, economic policy, tropical location, and life expectancy among other factors, countries with intensive malaria grew 1.3% less per person per year, and a 10% reduction in malaria was associated with 0.3% higher growth. Controlling for many other tropical diseases does not change the correlation of malaria with economic growth, and these diseases are not themselves significantly negatively correlated with economic growth. A second independent measure of malaria has a slightly higher correlation with economic growth in the 1980-1996 period. The paper concludes with speculation about the mechanisms that could cause malaria to have such a large impact on the economy, such as foreign investment and economic networks within the country.Public health, Economicsjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsWorking papersThe Changing Global Distribution of Malaria: A Reviewhttp://academiccommons.columbia.edu/catalog/ac:124056
Hamoudi, Amar A.; Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8044Fri, 25 Sep 2009 00:00:00 +0000Organized efforts to reduce the burden of malaria are as old as human societies. Understanding the historical relationships between humankind and malaria is important for natural and social scientists studying the disease, as well as policy makers trying to control it. Malaria once extended widely throughout the old world, reaching as far north as 64ÂºN latitude and as far south as 32ÂºS latitude. Today, however, malaria is almost exclusively a problem of the geographical tropics. Analysis of historical changes in malaria prevalence suggests a number of factors which help to determine the likelihood and sustainability of success in malaria control. Among these are geography, evolutionary history of flora and fauna, infrastructure, and land use. It is due to these factors, much more than socio-economic ones, that attempts to control or interrupt transmission of the disease have historically been most successful on islands, in temperate climates, or at high elevations.Public health, Economic historyjs2201Economics, Health Policy and Management, Earth Institute, International and Public AffairsWorking papersIncorporating a Rapid-Impact Package for Neglected Tropical Diseases with Programs for HIV/AIDS, Tuberculosis, and Malaria . . .http://academiccommons.columbia.edu/catalog/ac:124083
Hotez, Peter J.; Molyneux, David H.; Fenwick, Alan; Ottesen, Eric; Sachs, Sonia Ehrlich; Sachs, Jeffrey D.http://hdl.handle.net/10022/AC:P:8057Mon, 14 Sep 2009 00:00:00 +0000New initiatives in global health have done much to raise funds and elevate public awareness in order to launch a serious war on HIV/AIDS, tuberculosis, and malaria. Conspicuously absent from these activities, however, has been commensurate advocacy for a group of diseases that exclusively affect the poor and the powerless in rural and impoverished urban areas of developing countries. An increasing body of evidence indicates that this group of "neglected tropical diseases" may not only threaten the health of the poor as much as HIV/AIDS, tuberculosis, or malaria, but even more importantly, may have effective treatment and prevention strategies that can be delivered for less than US$1 per capita per year. Furthermore, new evidence points to substantial geographic overlap between the neglected tropical diseases and the big three, with emerging data suggesting that control of the neglected tropical diseases could actually become a powerful tool for combating HIV/AIDS, tuberculosis, and malaria. Therefore, achieving success in the global fight against HIV/AIDS, tuberculosis, and malaria may well require a concurrent attack on the neglected tropical diseases and waging a larger battle against a new 21st century "gang of four."Public healthss2632, js2201Institute of Human Nutrition, Economics, Health Policy and Management, Earth Institute, International and Public AffairsArticles